Volume 14

Using Tableau as a Data Visualization Tool to Explore Reoccurring Cancer Trends

Charbel Aoun
Maroun Sassine

Georgia State University

Key Words: cancer, cancer data, cancer research, cancer trends, data visualization

Abstract

Cancer has touched the lives of millions for over a century. Numerous organizations have cooperated in research and fundraising in order to find a cure for cancer. The need for an analysis of the various trends in cancer is evident in order to investigate the decline of cancer in recent years. To provide a clearer understanding of the different trends, the data visualization software, Tableau, was used to help visualize the data presented.

Introduction

Cancer is a group of diseases "characterized by the uncontrolled growth and spread of abnormal cells" (American Cancer Society, 2015a). If the intensity of the cells does not stay in a controllable condition, death is one of the possible results. Cancer results from numerous external and internal factors. "These [external or internal] factors may act together or in sequence" in order for a diagnosis to be a possibility (2015a). Many treatment options are possible, including surgery, radiation, chemotherapy, hormone therapy, immune therapy, and targeted therapy (2015a).

According to the World Health Organization (2007), an estimated eight million people died from cancer in 2010, and the number of deaths is projected to climb to twelve million by 2030. This alone is profoundly persuasive to bring cancer research to the forefront of medical investigation. Though it may seem overlooked, it is beneficial to investigate where trends occur in cancer rates. It is also beneficial to examine the factors that cause these patterns to occur, become prominent, or disappear over time.

During the investigation, numerous models were considered and analyzed. The trends were investigated and consolidated into multiple groups. These groups include cancer diagnosis and death rates in adults, children, and adolescents; cancer cases by state; and cancer deaths by country. Colored data visualization images accompany each trend. These images were produced using the software Tableau to depict the data collected on the different patterns.

Discussion

Comparing Men's and Women's Chances with Cancer

The first major trend investigated is the cancer diagnosis rates in both men and women. Both men and women are estimated to have both high new cancer cases and death cases. For 2014, male cases were estimated at 855,220 for all cancer sites while female cases were estimated at 810,320 in all sites. For cancer deaths, men experienced an estimated 310,010 deaths while women's deaths were estimated at 275,710 (American Cancer Society, 2014).

Analyzing cancer in men. The first data visualized image (see Figure 1) compares diagnosis and death percentages in men (2014).

Figure 1.

In this picture, there is a relationship displayed between the diagnosis and death rates. The color of the circles represents the diagnosis rates for the cancer types analyzed. The darker the color, the higher the diagnosis rate. This graph shows that prostate cancer is the highest diagnosed cancer in men.

Prostate cancer. In the late 1980s and early 1990s, incidence rates for prostate cancer spiked dramatically because of increased use of the prostate-specific antigen (PSA) blood test for screening (American Cancer Society, 2015a). Rates have since been declining. Cases of prostate cancer are significantly higher in men sixty-five and older than any other age group.

Prostate cancer death rates have been decreasing since the early 1990s in men of all races/ethnicities, though they remain more than twice as high in blacks as in any other group (2015a). To catch these cases before death can be rather difficult as early prostate cancer usually has no symptoms. The only well-established risk factors for prostate cancer are increasing age, African ancestry, a family history of the disease and certain inherited genetic conditions (2015a).

The second variable graphed in Figure 1 is death rates in the cancer types. The size of the circle represents the death rates for each cancer types depicted. The larger the circle, the higher mortality rate. In this case, lung cancer causes the most cancer deaths in men today. A further analysis of cancer deaths will be investigated in the section titled "Cancer Deaths in the Past 70 years."

Analyzing cancer in women. Just as the diagnosis and death rates for cancer in men were digitally presented using a bubble chart, diagnosis and death rates for women were graphed using a bubble chart as follows in Figure 2 (American Cancer Society, 2014).

Figure 2.

The first variable graphed is diagnosis rates, depicted using the color of the circles. The darker the red, the higher the diagnosis rate. In the provided data visualized image, breast cancer has the highest recorded diagnosis rate in women.

Breast cancer. Potentially modifiable factors associated with increased breast cancer risk include weight gain after the age of 18 or being overweight or obese (for postmenopausal breast cancer), physical inactivity, and alcohol consumption. In addition, recent research indicates that long-term, heavy smoking may also increase breast cancer risk, particularly among women who start smoking before their first pregnancy (American Cancer Society, 2015a). The International Agency for Research on Cancer (IARC) has concluded that shift work, particularly at night, may be associated with an increased risk of breast cancer (IARC, 2012).

Mammography can often detect breast cancer at an early stage, therefore, treatment is more effective. Numerous studies have shown that early detection with mammography saves lives and increases treatment options. Mammography will detect most breast cancers in women without symptoms, "though the sensitivity is lower for younger women" (American Cancer Society, 2015a). Mammography also results in some detection of cancer that would neither have caused harm nor been diagnosed in the absence of screening.

The second variable depicted in Figure 2 is death rates, represented by the size of the circles. Lung cancer is the cancer type causing the most death not only in men but also in women in 2014 and 2015. To understand the reason lung cancer causes the highest death rate, an investigation of deaths will be looked at next.

Cancer Deaths in the Past 70 Years

The following graph, Figure 3, represents the total number of fatalities in the United States by cancer from the year 1930 until 2010 (American Cancer Society, 2014). This legend distinguishes the cancer locations:

blue represents colon cancer orange represents breast cancer green represents leukemia red represents liver cancer purple represents lung cancer

brown represents ovarian cancer pink represents pancreatic cancer gray represents prostate cancer olive represents stomach cancer baby blue represents uterine cancer

Figure 3.

The data shows that, over time, lung cancer has climbed to exceed other types for the highest cancer death rate. To understand the reason of this, a further analysis of lung cancer is necessary.

Lung cancer. Over the past century, lung cancer rates grew to an all-time high as a result of the tobacco epidemic (American Cancer Society, 2011). Cigarette smoking is the largest cause of lung cancer, and the risk factor increases as the number of cigarettes and the number of times consumed in a particular interval increases. Cigarette consumption has increased over time due to the influence of many factors. For this reason, diagnosis and death rates have increased.

Events influencing cigarette use. The timeline of events affecting cigarette consumption stretches over a time span of more than a century. It began in 1884 and 1889, where the invention of a machine to manufacture cigarettes and the invention of the safety matches, respectively, ignited the beginning of the mass production of cigarette (Whelan, 1984). As mass production began in flourish, mass marketing of cigarettes influenced a higher consumption rate as well. As stated by Burrough and Helyar in 1990, the "introduction and mass marketing of Camel brand cigarettes by R.J. Reynolds Tobacco Company in 1913" played one of these influential roles. Almost two decades passed after this introduction before, in 1928, companies began "cigarette advertisements targeting women, including the 'Reach for a Lucky Instead of a Sweet' campaign" (Burns, 1994 and Health Advocacy Center, 1986). Also, marketing of filtered cigarettes began in 1955 (U.S. Department of Health and Human Services, 1981).

After almost a century of companies attracting customers to cigarettes, actions were taken to counteract the rise in cigarette consumption and death. Publications were first written about the "retrospective studies linking tobacco and disease [in 1950] and the prospective mortality studies linking cigarettes and lung cancer [in 1954]" (U.S. Department of Health and Human Services, 1989). After these publications, according to Freedman and Cohen (1993), the Council for Tobacco Research was founded. According to the 1964 publication by the U.S. Department of Health, Education, and Welfare, the Surgeon General released a 1964 report on smoking as it relates to health. Counter-advertising on television between 1967 and 1970 aided in the retaliatory efforts against cigarette consumption (Warner, 1977). Even with all these efforts to minimize the quantity of cigarette use, "the introduction of Virginia Slims" and other brands of cigarettes targeting women began in 1968 (Burns, 1994).

It was in the 1970s and onward that initiatives were taken to combat this epidemic. Examples include the ban on cigarette advertisements (U.S. Department of Health and Human Services, 1989), the start of the Nonsmokers' rights movement (Steinfeld, 1972), and the release of reports from the U.S. Surgeon General in 1986 on "involuntary smoking" (U.S. Department of Health and Human Services, 1986) and from the U.S. Environmental Protection Agency on "environmental tobacco smoke" (U.S. Environmental Protection Agency, 1992).

These historical events illuminate the fact that efforts have been made to lower the chances of tobacco related sickness and disease; however, the graph demonstrates that as time passed, the number of deaths from lung cancer have increased. This correlation shows the dramatic effects of tobacco upon the numerous diseases it causes including lung cancer.

Cancer Chances in the Youth Population

Although cancer is much less common among children compared to older adults, "1 in 285 children in the US will be diagnosed with the disease before the age of 20" (American Cancer Society, 2014). The types of cancers that develop in children and adolescents differ from those that develop in adults. The predominant types of pediatric cancers in children from ages 0-14 and adolescents from 15-19, are pictured below in the next data visualized image (American Cancer Society, 2014).

Figure 4.

Some of the cancers that develop in children are rarely seen in older individuals, notably those cancers that arise from embryonic cells which include "neuroblastoma (sympathetic peripheral nervous system), Wilms tumor or nephroblastoma (developing kidney), medulloblastomas (brain), rhabdomyosarcomas (muscle), and retinoblastoma (retina of the eye)" (American Cancer Society, 2014). Because these cancers occur during stages of rapid growth and development in youth, most experts strongly recommend that they are treated at medical centers that specialize in childhood cancer by multidisciplinary teams.

From 1975 to 2010, the overall incidence of pediatric cancer in the US increased slightly, by an average of 0.6% per year (Howlader, N., Noone, A.M., & Krapcho, M., 2013). Specifically, incidence rates increased for four cancer types: acute lymphocytic leukemia, acute myeloid leukemia, non-Hodgkin lymphoma, and testicular germ cell tumors. Reasons for increases in incidence rates are largely unknown. It is possible that some of this increase may be due to changes in environmental factors. Improved diagnosis and access to medical care over time may also have contributed. Without medical attention, some children may die of infections or other complications of their cancers without ever being diagnosed. Death rates, on the other hand, for all childhood and adolescent cancers combined declined steadily from 1975 to 2010 by an average of 2.1% per year, resulting in an overall reduction of more than 50% (2013). Mortality declines were observed for all sites with the steepest declines in Hodgkin lymphoma, non-Hodgkin lymphoma, and acute lymphocytic leukemia.

Cancer Cases by State

The investigation continues now with broadening our perspective by looking at different cancer trends by locations as opposed to by individuals. The United States is mapped in the next visualization, Figure 5, comparing the number of cancer cases to the population as a percentage. A divergent scale was used to define the lower rates of cancer cases per population size compared to higher percentages. The green represents low percentages. As the green changes from a dark green to a light green, the percentage of cases increases. Then the color diverges from light green to light red. Then the red darkens as the percentage continues to increase, creating the map.

Figure 5.

With this in mind, we see from the map that most cancer cases occur in the northeastern region of the United States. Cancer most commonly develops in older people; "78% of all cancer diagnoses are in people 55 years of age or older" (American Cancer Society, 2015a). People who smoke, eat an unhealthy diet or are physically inactive also have a higher risk of cancer. These same risks plague American culture today. Because the population is most heavily concentrated in the northeast, this data supports the idea of greater incidence of cancer cases in densely populated areas.

Another location experiencing higher cancer rates in the United States is the southeast. As depicted, Georgia is the only state with a low percentage of cases in comparison to other states in the southeast due to the number of recorded melanoma (skin cancer) cases. For melanoma, one of the major risk factors is sun sensitivity; the skin's reaction to the presence of excessive sunlight. As most use tanning beds or tan on the beach, it is evident that many experience sunburns; however, the UVA and UVB rays that penetrate the skin cause the cells to mutate and become cancer cells. As a result, melanoma and all other skin cancer types are the most common form of cancer (2015).

Cancer Deaths by Country

As the final visualization of the investigation, Figure 6 (below) brings together data from every country. The analysis shows the number of people who have died of cancer in comparison to the population size to indicate the percentage of people who died of cancer by country. A blue-red divergent scale was used for this trend as well; blue indicates a lower percentage and red points to higher percentages.

Figure 6.

This map illustrates that developed countries have higher mortality rates than developing nations. The red nations have been recorded to have contributing factors resulting from geographic differences that include the age groups, the prevalence of risk factors, the availability and use of diagnostic tests, and the availability and quality of treatment; in which case "approximately 16% of all incident cancers worldwide are attributable to infections. This percentage is about three times higher in developing countries (23%) than in developed countries (7%)" (Cancer Genome Atlas Network, 2012).

The estimated number of cases and deaths in economically developing countries will probably grow, however, due to the adoption of lifestyles that are known to increase cancer risk – such as smoking, poor diet, physical inactivity, and fewer pregnancies. Cancers related to these factors, such as lung, breast, and colorectal cancers, are already on the rise in economically transitioning countries.

According to estimates from the International Agency for Research on Cancer, there were 14.1 million new cancer cases in 2012 worldwide, of which 8 million occurred in economically developing countries containing about 82% of the world's population (IARC, 2012). By 2030, the global burden is expected to grow to 21.7 million new cancer cases and 13 million cancer deaths simply due to the growth and aging of the population (American Cancer Society, 2015b).

Summary

Cancer knows no boundaries, yet over the years, scientists and advocates united and fought to find the reasons behind cancer and why so many are affected by it. This investigation analyzed the reasons behind the most common cancer cases in all individuals, then compared these cases in the fifty states and finally in each country. One constant remained: cancer plays a vital role in the lives of people by the millions and has done so for over a century. But hope is inevitable. So many began the fight to stop these trends and began the initiative to create new trends; trends that eradicate cancer from the world permanently.

References

Appendix

Table A1

Male Diagnosis and Death Rates

Cancer Type	Percent Males Diagnosed	Percent Male Deaths
Prostate	27	10
Lung	14	28
Colon	8	8
Urinary Bladder	7	4
Skin	5	1
Kidney	5	3
Non-Hodgkin Lymphoma	4	4
Oral Cavity	4	1
Leukemia	4	5
Liver	3	5
Pancreas	1	7
Esophagus	1	4

Table A2

Female Diagnosis and Death Rates

Cancer Type	Percent Females Diagnosed	Percent Female Deaths
Breast	29	15
Lung	13	26
Colon	8	9
Uterine corpus	6	3
Thyroid	6	1
Non-Hodgkin lymphoma	4	3
Skin	4	1
Kidney	3	1
Pancreas	3	7
Leukemia	3	4
Ovary	1	5
Liver	1	3
Brain	1	2

Table A3

Children and Adolescent Diagnosis and Death Rates

Cancer Type	Percent Children Diagnosed	Percent Adolescents Diagnosed	Description of Cancer Type
Acute lymphocytic leukemia	26	8	Cancer from white blood cells
Acute myeloid leukemia	5	4	Cancer that starts inside bone marrow, the soft tissue inside bones that helps form blood cells
Bone tumor	4	7	Cancer within the bone
Brain and CNS	21	10	Cacner of the brain and central nervous system
Hodgkin lymphoma	4	15	Cancer of lymph tissue. Lymph tissue is found in the lymph nodes, spleen, liver, bone marrow, and other sites
Melanoma	1	6	Most dangerous type of skin cancer
Neuroblastoma	7	1	Cacner tumor that develops in the nerve tissue
Non-Hodgkin lymphoma	6	8	Cancer of lymphocytes (white blood cells)
Ovarian germ cell tumors	1	2	An abnormal mass of tissue that forms in germ (egg) cells in the ovary (female reproductive gland in which the eggs are formed
Retinoblastoma	3	1	Cacner of the retina
Rhabdomyosarcoma	3	1	Cancer that forms in the soft tissues in a type of muscle called striated muscle anywhere in the body.
Testicular germ cell tumors	1	8	Cancer that forms in tissues of one or both testicles
Thyroid carcinoma	1	11	Cancer that forms in the thyroid gland. Carcinoma is a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs.
Wilms tumor	5	1	A disease in which malignant (cancer) cells are found in the kidney, and may spread to the lungs, liver, or nearby lymph nodes

Table A4

Death Rates in the Past 70 Years

Year	Colon	Breast	Leukemia	Liver	Lung	Ovary	Pancreas	Prostate	Stomach	Uterus
1930	61,681	37,104	3,681	17,398	8,485	8,995	10,204	21,847	100,348	36,167
1931	63,721	37,946	3,927	16,609	9,087	8,889	10,868	22,877	98,599	33,516
1932	67,091	38,586	3,960	16,233	10,265	9,245	11,707	24,704	98,369	32,680
1933	68,369	38,723	4,332	16,360	10,886	9,466	11,751	26,002	96,336	30,817
1934	71,719	39,951	4,490	16,175	12,017	10,124	12,422	28,707	95,576	30,039
1935	73,400	39,805	4,898	15,478	13,956	10,582	13,164	28,867	95,530	30,072
1936	76,453	41,037	5,011	15,402	15,247	11,163	14,228	30,435	95,194	28,784
1937	79,646	40,725	5,283	14,864	16,468	11,334	14,492	31,236	92,388	28,309
1938	82,603	42,102	5,784	14,723	18,151	11,541	15,680	33,389	91,870	27,199
1939	85,228	42,558	6,300	14,545	19,151	11,877	16,431	35,012	87,962	26,903
1940	87,627	44,595	7,199	13,891	20,705	12,517	16,090	36,266	86,903	26,852
1941	87,481	43,573	7,114	13,951	22,584	12,759	17,270	38,238	84,166	25,574
1942	88,779	44,217	7,552	14,254	24,032	13,310	17,331	36,495	85,152	25,522
1943	92,556	44,624	7,794	14,989	25,792	13,606	16,753	37,296	82,620	24,995
1944	94,172	44,325	8,123	15,480	27,594	13,900	17,657	38,618	81,253	24,664
1945	97,122	46,021	8,525	15,709	29,742	14,281	19,109	41,025	80,669	24,323
1946	97,964	46,702	9,255	14,423	33,352	14,212	19,816	42,792	79,419	23,841
1947	101,892	48,309	10,326	13,778	38,336	14,748	21,920	44,213	80,290	23,569
1948	103,519	50,748	10,934	14,354	42,485	14,970	23,663	46,844	80,932	22,885
1949	100,579	47,517	11,335	13,270	41,651	14,971	24,942	43,645	75,819	22,359
1950	99,645	48,519	12,459	13,050	45,884	15,492	25,379	44,072	74,229	21,758
1951	99,376	48,915	13,503	12,790	49,145	15,654	26,352	44,277	71,506	21,285
1952	101,360	49,764	13,941	12,744	53,709	15,739	27,578	46,742	70,510	20,593
1953	103,200	51,535	14,498	12,785	58,345	16,427	28,538	47,747	69,934	20,717
1954	103,993	51,814	15,281	12,505	61,490	16,857	30,225	49,687	68,604	20,502
1955	106,493	53,991	15,889	12,444	66,550	16,771	31,194	50,111	65,462	19,874
1956	107,589	54,492	16,596	12,511	72,189	17,452	33,935	52,317	65,282	19,583
1957	109,065	55,215	17,073	12,811	76,236	18,230	33,641	52,712	62,881	18,753
1958	109,359	54,717	18,187	12,483	80,185	18,537	34,793	51,737	61,005	18,877
1959	110,441	55,372	18,154	12,126	85,291	18,494	36,242	51,444	61,231	18,153
1960	113,195	57,452	18,940	13,023	91,010	18,790	37,170	52,970	60,169	18,013
1961	114,542	58,204	19,946	12,688	97,244	18,369	38,854	54,830	58,133	17,609
1962	115,487	58,652	19,832	12,385	103,440	18,840	40,145	55,447	55,837	17,972
1963	115,965	59,076	20,798	12,929	109,690	19,113	41,266	56,511	56,051	17,453
1964	117,017	60,685	20,702	13,097	115,219	19,765	41,040	56,441	53,036	17,225
1965	119,031	62,167	21,125	13,326	122,495	19,042	42,716	57,978	51,418	17,214
1966	120,519	62,639	21,941	13,308	130,320	19,263	43,559	57,988	49,980	16,980
1967	119,509	63,704	22,416	13,440	137,970	18,878	44,503	59,249	48,253	16,793
1968	121,147	65,029	22,460	13,556	151,159	19,067	45,598	60,375	47,360	16,614
1969	123,228	64,343	22,932	13,377	158,291	19,052	46,172	60,154	45,689	16,353
1970	123,441	65,987	22,469	13,123	166,912	19,480	46,406	61,471	44,264	16,349
1971	123,766	65,867	22,864	13,498	176,096	19,520	45,898	62,583	42,863	16,335
1972	125,728	67,830	22,805	13,433	184,499	19,520	45,560	63,792	41,890	16,792
1973	124,179	68,731	23,035	12,926	189,658	19,708	47,371	65,700	40,885	16,317
1974	127,457	68,745	23,019	13,045	198,243	20,316	47,026	65,987	40,257	16,467
1975	126,128	67,816	23,598	12,742	205,175	20,301	47,848	66,455	39,132	16,414
1976	129,949	69,322	23,615	12,864	214,765	20,713	48,352	68,834	38,506	16,353
1977	129,721	71,500	23,819	13,214	223,543	20,703	49,863	69,869	37,119	16,298
1978	132,883	70,621	24,071	13,355	232,601	21,368	49,903	72,555	36,742	16,249
1979	132,783	70,202	24,789	13,278	238,559	22,055	49,899	73,701	36,376	15,979
1980	133,835	72,030	25,560	13,179	249,038	22,041	49,925	75,623	35,747	16,133
1981	132,402	73,240	24,958	13,997	254,248	21,340	50,627	76,098	35,751	15,833
1982	132,975	74,576	25,526	14,132	264,329	22,240	50,644	77,288	35,128	15,985
1983	133,729	74,990	25,501	14,495	271,199	21,743	51,258	79,317	34,362	16,132
1984	135,363	77,585	25,156	14,621	278,038	21,460	52,267	80,327	34,410	15,800
1985	134,665	78,459	25,571	14,751	284,795	21,651	52,011	80,694	33,160	15,703
1986	132,553	78,935	25,668	15,128	290,801	21,372	52,006	83,877	32,757	15,849
1987	132,532	79,125	24,908	15,264	299,227	21,806	52,632	85,088	32,257	15,749
1988	130,562	81,177	25,866	15,892	304,890	22,249	52,582	87,741	31,818	16,381
1989	130,321	82,023	26,162	16,537	311,733	22,954	53,821	91,578	33,021	16,290
1990	130,456	82,564	26,690	16,962	319,531	23,198	54,627	96,283	32,676	16,463
1991	128,081	82,446	26,473	17,397	323,227	22,944	55,216	99,086	32,524	16,388
1992	127,497	80,578	27,284	18,360	325,118	22,695	55,844	99,958	30,599	17,085
1993	126,811	80,932	27,579	18,558	328,626	22,682	56,189	101,294	30,930	27,579
1994	125,980	80,429	27,591	19,261	327,704	22,905	56,483	100,211	30,194	27,591
1995	125,339	80,406	28,379	20,233	328,982	22,335	55,969	98,011	29,955	28,379
1996	121,987	78,231	27,845	20,685	328,570	21,746	56,485	95,468	28,906	27,845
1997	121,288	75,504	27,845	20,884	328,521	21,687	57,029	91,568	28,381	27,845
1998	120,013	74,332	27,300	21,624	328,142	21,894	58,114	88,117	27,570	27,300
1999	119,984	72,536	27,814	20,997	320,684	86,170	58,901	86,170	26,996	27,814
2000	122,176	75,055	29,063	22,573	332,952	85,777	60,383	85,777	27,088	29,063
2001	120,257	74,092	29,067	23,082	332,844	84,066	61,268	84,066	26,217	29,067
2002	118,789	73,632	29,338	23,873	332,782	82,548	61,552	82,548	25,886	29,338
2003	116,333	73,397	29,011	24,659	329,853	78,909	62,083	78,909	25,239	29,011
2004	110,973	71,737	28,695	24,888	327,064	76,715	63,539	76,715	24,888	28,695
2005	108,750	71,220	28,961	26,005	326,546	75,061	64,718	75,061	23,641	28,961
2006	107,715	70,418	28,943	25,959	321,952	72,208	65,644	72,208	23,274	28,943
2007	106,335	69,283	28,617	26,810	318,100	72,898	66,572	72,898	22,894	28,617
2008	104,608	68,725	28,889	28,281	313,521	69,942	67,509	69,942	22,503	28,889
2009	101,541	68,103	29,143	29,450	307,999	67,797	67,183	67,797	21,781	29,143
2010	100,539	67,748	28,770	30,007	304,091	67,438	68,985	67,438	21,964	28,770

Table A5

Cancer Cases by State

State	Number of cases	State Population	Percent of Population with Cancer Cases
Alabama	26,150	4,849,377	0.5392
Alaska	3,700	736,732	0.5022
Arizona	32,440	6,731,484	0.4819
Arkansas	15,830	2,966,369	0.5336
California	172,090	38,802,500	0.4435
Colorado	24,540	5,355,866	0.4582
Connecticut	21,970	3,596,677	0.6108
Delaware	5,280	935,614	0.5643
District of Columbia	2,800	658,893	0.4250
Florida	114,040	19,893,297	0.5733
Georgia	48,070	10,097,343	0.4761
Hawaii	6,730	1,419,561	0.4741
Idaho	8,080	1,634,464	0.4944
Illinois	65,460	12,880,580	0.5082
Indiana	35,620	6,596,855	0.5400
Iowa	17,140	3,107,126	0.5516
Kansas	14,440	2,904,021	0.4972
Kentucky	26,490	4,413,457	0.6002
Louisiana	24,100	4,649,676	0.5183
Maine	8,810	1,330,089	0.6624
Maryland	30,050	5,976,407	0.5028
Massachusetts	37,790	6,745,408	0.5602
Michigan	57,420	9,909,877	0.5794
Minnesota	29,730	5,457,173	0.5448
Mississippi	16,260	2,994,079	0.5431
Missouri	34,680	6,063,589	0.5719
Montana	5,950	1,023,579	0.5813
Nebraska	9,540	1,881,503	0.5070
Nevada	13,640	2,839,099	0.4804
New Hampshire	8,090	1,326,813	0.6097
New Jersey	51,410	8,938,175	0.5752
New Mexico	9,970	2,085,572	0.4780
New York	107,840	19,746,227	0.5461
North Carolina	50,420	9,943,964	0.5070
North Dakota	3,840	739,482	0.5193
Ohio	65,010	11,594,163	0.5607
Oklahoma	19,280	3,878,051	0.4972
Oregon	22,410	3,970,239	0.5644
Pennsylvania	81,540	12,787,209	0.6377
Rhode Island	6,040	1,055,173	0.5724
South Carolina	25,550	4,832,482	0.5287
South Dakota	4,520	853,175	0.5298
Tennessee	38,300	6,549,352	0.5848
Texas	113,630	26,956,958	0.4215
Utah	11,050	2,942,902	0.3755
Vermont	4,020	626,562	0.6416
Virginia	41,170	8,326,289	0.4945
Washington	38,130	7,061,530	0.5400
West Virginia	11,730	1,850,326	0.6339
Wisconsin	32,700	5,757,564	0.5679
Wyoming	2,860	584,153	0.4896

Table A6

Cancer Deaths by Country

Country Name	2013 Population by Country	Number of Deaths by Country in 2013	Percent of Population Who Died of Cancer
Afghanistan	30,551,674	30,949	0.1013
Albania	2,773,620	4,099	0.1478
Algeria	39,208,194	34,150	0.0871
Andorra	79,218	84	0.1061
Angola	21,471,618	18,079	0.0842
Antigua and Barbuda	89,985	118	0.1307
Argentina	41,446,246	56,077	0.1353
Armenia	2,976,566	5,161	0.1734
Australia	23,130,900	27,480	0.1188
Austria	8,473,786	10,474	0.1236
Azerbaijan	9,416,598	12,684	0.1347
Bahamas, The	377,374	413	0.1094
Bahrain	1,332,171	1,164	0.0874
Bangladesh	156,594,962	164,425	0.1050
Barbados	284,644	387	0.1358
Belarus	9,466,000	12,666	0.1338
Belgium	11,195,138	14,274	0.1275
Belize	331,900	335	0.1010
Benin	10,323,474	9,074	0.0879
Bhutan	753,947	941	0.1248
Bolivia	10,671,200	9,188	0.0861
Bosnia and Herzegovina	3,829,307	4,097	0.1070
Botswana	2,021,144	1,199	0.0593
Brazil	200,361,925	229,815	0.1147
Brunei Darussalam	417,784	405	0.0969
Bulgaria	7,265,115	10,091	0.1389
Burkina Faso	16,934,839	16,376	0.0967
Burundi	10,162,532	10,732	0.1056
Cambodia	15,135,169	16,800	0.1110
Cameroon	22,253,959	17,581	0.0790
Canada	35,158,304	44,229	0.1258
African Republic	4,616,417	3,615	0.0783
Chad	12,825,314	10,453	0.0815
Chile	17,619,708	21,214	0.1204
China	1,357,380,000	1,969,558	0.1451
Colombia	48,321,405	49,336	0.1021
Comoros	734,917	655	0.0891
Congo, Rep.	67,513,677	57,792	0.0856
Costa Rica	4,447,632	3,482	0.0783
Croatia	4,872,166	5,325	0.1093
Cuba	4,252,700	7,038	0.1655
Cyprus	11,265,629	15,952	0.1416
Czech Republic	1,141,166	947	0.0830
Congo, Dem. Rep.	10,521,468	16,634	0.1581
Denmark	5,613,706	8,853	0.1577
Djibouti	872,932	752	0.0861
Dominica	72,003	112	0.1554
Dominican Republic	10,403,761	10,799	0.1038
Ecuador	15,737,878	19,090	0.1213
Egypt, Arab Rep.	82,056,378	74,261	0.0905
El Salvador	6,340,454	6,271	0.0989
Equatorial Guinea	757,014	619	0.0818
Eritrea	6,333,135	5,276	0.0833
Estonia	1,324,612	1,978	0.1493
Ethiopia	94,100,756	86,196	0.0916
Fiji	881,065	1,001	0.1136
Finland	5,439,407	5,793	0.1065
France	66,028,467	91,383	0.1384
Gabon	1,671,711	1,244	0.0744
Gambia, The	1,849,285	1,772	0.0958
Georgia	4,476,900	4,266	0.0953
Germany	80,621,788	102,793	0.1275
Ghana	25,904,598	24,299	0.0938
Greece	11,032,328	14,066	0.1275
Grenada	105,897	165	0.1555
Guatemala	15,468,203	17,943	0.1160
Guinea	11,745,189	11,839	0.1008
Guinea-Bissau	1,704,255	1,595	0.0936
Guyana	799,613	654	0.0818
Haiti	10,317,461	10,658	0.1033
Honduras	8,097,688	10,908	0.1347
Hungary	9,897,247	18,755	0.1895
Iceland	323,002	386	0.1194
India	1,252,139,596	939,105	0.0750
Indonesia	249,865,631	302,088	0.1209
Iran, Islamic Rep.	77,447,168	71,794	0.0927
Iraq	33,417,476	31,713	0.0949
Ireland	4,595,281	6,314	0.1374
Israel	8,059,400	9,494	0.1178
Italy	59,831,093	74,310	0.1242
Jamaica	2,715,000	3,386	0.1247
Japan	127,338,621	146,567	0.1151
Jordan	6,459,000	6,369	0.0986
Kazakhstan	17,037,508	25,710	0.1509
Kenya	44,353,691	50,918	0.1148
Kiribati	102,351	55	0.0535
Korea, Dem. Rep.	24,895,480	26,489	0.1064
Korea, Rep.	50,219,669	63,227	0.1259
Kuwait	3,368,572	2,112	0.0627
Kyrgyz Republic	5,719,500	6,532	0.1142
Lao PDR	6,769,727	8,577	0.1267
Latvia	2,013,385	3,145	0.1562
Lebanon	4,467,390	5,897	0.1320
Lesotho	2,074,465	1,394	0.0672
Liberia	4,294,077	3,899	0.0908
Libya	6,201,521	5,984	0.0965
Lithuania	2,956,121	4,526	0.1531
Luxembourg	543,202	670	0.1234
Macedonia, FYR	2,107,158	2,737	0.1299
Madagascar	22,924,851	27,028	0.1179
Malawi	16,362,567	15,414	0.0942
Malaysia	29,716,965	30,668	0.1032
Maldives	345,023	902	0.2615
Mali	15,301,650	17,306	0.1131
Malta	423,282	483	0.1142
Marshall Islands	52,634	61	0.1152
Mauritania	3,889,880	3,734	0.0960
Mauritius	1,296,303	1,134	0.0875
Mexico	122,332,399	99,701	0.0815
Micronesia, Fed. Sts.	103,549	87	0.0844
Moldova	3,559,000	4,655	0.1308
Monaco	37,831	46	0.1208
Mongolia	2,839,073	5,854	0.2062
Morocco	33,008,150	26,803	0.0812
Mozambique	25,833,752	23,896	0.0925
Myanmar	53,259,018	63,804	0.1198
Namibia	2,303,315	1,278	0.0555
Nepal	27,797,457	32,356	0.1164
Netherlands	16,804,224	24,719	0.1471
New Zealand	4,470,800	5,884	0.1316
Nicaragua	6,080,478	5,880	0.0967
Niger	17,831,270	13,962	0.0783
Nigeria	173,615,345	162,157	0.0934
Norway	5,084,190	6,625	0.1303
Oman	3,632,444	2,713	0.0747
Pakistan	182,142,594	172,671	0.0948
Palau	20,918	20	0.0980
Panama	3,864,170	4,104	0.1062
Papua New Guinea	7,321,262	9,379	0.1281
Paraguay	6,802,295	7,877	0.1158
Peru	30,375,603	34,993	0.1152
Philippines	98,393,574	84,323	0.0857
Poland	38,530,725	65,233	0.1693
Portugal	10,459,806	14,048	0.1343
Qatar	2,168,673	1,919	0.0885
Romania	19,963,581	28,608	0.1433
Russian Federation	143,499,861	186,263	0.1298
Rwanda	11,776,522	13,001	0.1104
Samoa	190,372	102	0.0537
San Marino	31,448	36	0.1150
Sao Tome and Principe	192,993	293	0.1516
Saudi Arabia	28,828,870	20,468	0.0710
Senegal	14,133,280	13,794	0.0976
Serbia	7,163,976	12,265	0.1712
Seychelles	89,173	136	0.1524
Sierra Leone	6,092,075	6,080	0.0998
Singapore	5,399,200	6,279	0.1163
Slovak Republic	5,414,095	8,554	0.1580
Slovenia	2,060,484	3,210	0.1558
Solomon Islands	561,231	482	0.0858
Somalia	10,495,583	10,485	0.0999
South Africa	52,981,991	82,334	0.1554
Spain	46,647,421	56,957	0.1221
Sri Lanka	20,483,000	17,267	0.0843
St. Kitts and Nevis	54,191	78	0.1443
St. Lucia	182,273	215	0.1177
St. Vincent and the Grenadines	109,373	128	0.1167
Sudan	37,964,306	27,524	0.0725
Suriname	539,276	494	0.0916
Swaziland	1,249,514	988	0.0791
Sweden	9,592,552	11,166	0.1164
Switzerland	8,081,482	9,108	0.1127
Syrian Arab Republic	22,845,550	12,634	0.0553
Tajikistan	8,207,834	6,648	0.0810
Tanzania	49,253,126	37,137	0.0754
Thailand	67,010,502	70,964	0.1059
Timor-Leste	1,178,252	1,267	0.1075
Togo	6,816,982	5,951	0.0873
Tonga	105,323	86	0.0820
Trinidad and Tobago	1,341,151	1,529	0.1140
Tunisia	10,886,500	10,505	0.0965
Turkey	74,932,641	86,098	0.1149
Turkmenistan	5,240,072	5,444	0.1039
Tuvalu	9,876	13	0.1314
Uganda	37,578,876	49,905	0.1328
Ukraine	45,489,600	50,903	0.1119
United Arab Emirates	9,346,129	5,533	0.0592
United Kingdom	64,097,085	87,813	0.1370
United States	316,128,839	391,368	0.1238
Uruguay	3,407,062	5,591	0.1641
Uzbekistan	30,241,100	21,139	0.0699
Vanuatu	252,763	244	0.0965
Venezuela, RB	30,405,207	29,797	0.0980
Vietnam	89,708,900	102,089	0.1138
Yemen, Rep.	24,407,381	20,185	0.0827
Zambia	14,538,640	15,440	0.1062
Zimbabwe	14,149,648	16,244	0.1148

Author's Note

This project would not be possible without the support of the various colleagues and resources I have worked with and used in the process of completing this manuscript.

First, I would like to thank Joe Hurley and my colleagues at the Georgia State University Collaborative University Research and Visualization Environment (CURVE) for their help in the use of the equipment and the program Tableau provided at CURVE. Without their help, the images presented in this article would not be possible.

Second, I would like to thank Preston Berger – a student at the University of Georgia that I have known for almost ten years now – for his recommendations, revisions, and additions in order to strengthen the language presented in the report.

Third, I would like to thank the co-author of this manuscript, Maroun Sassine, for his efforts and dedication to this project from the very beginning. His planning and attention to detail are admirable and beneficial to the success of the report.

Finally, and most importantly, I want to thank my family for believing in me; in always supporting me in everything that I do, and encouraging me to reach the unreachable boundaries of life and to persevere with ambition and integrity.

– Charbel Aoun